Individual
DALLAS WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
600 HOLIDAY PLAZA DR, MATTESON, IL 60443-2241
(773) 641-8166
Mailing address
1316 MEYER CT, HOMEWOOD, IL 60430-4544
(773) 641-8166
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/25/2024
Last updated
01/25/2024
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